Bundled Services/Supplies

20.3 - Bundled Services/Supplies (Rev. 147, 04-23-04) There are a number of services/supplies that are covered under Medicare and that have HCPCS codes, but they are services for which Medicare bundles payment into the payment for other related services. If A/B MACs (B) receive a claim that is solely for a service or supply that must be mandatorily bundled, the claim for payment should be denied by the A/B MAC (B). A. Routinely Bundled Separate payment is never made for routinely bundled services and supplies. The CMS has provided RVUs for many of the bundled services/supplies. However, the RVUs are not for Medicare payment use. A/B MACs (B) may not establish their own relative values for these services. B. Injection Services Injection services (codes 90782, 90783, 90784, 90788, and 90799) included in the fee schedule are not paid for separately if the physician is paid for any other physician fee schedule service rendered at the same time. A/B MACs (B) must pay separately for those injection services only if no other physician fee schedule service is being paid. In either case, the drug is separately payable. If, for example, code 99211 is billed with an injection service, pay only for code 99211 and the separately payable drug. (See section 30.6.7.D.) Injection services that are immunizations with hepatitis B, pneumococcal, and influenza vaccines are not included in the fee schedule and are paid under the drug pricing methodology as described in Chapter 17. C. Global Surgical Packages The MPFSDB lists the global charge period applicable to surgical procedures. D. Intra-Operative and/or Duplicate Procedures Chapter 23 and §30 of this chapter describe the correct coding initiative (CCI) and policies to detect improper coding and duplicate procedures. E. EKG Interpretations For services provided between January 1, 1992, and December 31, 1993, A/B MACs (B) must not make separate payment for EKG interpretations performed or ordered as part of, or in conjunction with, visit or consultation services. The EKG interpretation codes that are bundled in this way are 93000, 93010, 93040, and 93042. Virtually, all EKGs are performed as part of or ordered in conjunction with a visit, including a hospital visit. If the global code is billed for, i.e., codes 93000 or 93040, A/B MACs (B) should assume that the EKG interpretation was performed or ordered as part of a visit or consultation. Therefore, they make separate payment for the tracing only portion of the service, i.e., code 93005 for 93000 and code 93041 for 93040. When the A/B MAC (B) makes this assumption in processing a claim, they include a message to that effect on the Medicare Summary Notice (MSN). For services provided on or after January 1, 1994, A/B MACs (B) make separate payment for an EKG interpretation.